Esophageal erosion as a possible bacterial entry site in an acute lymphoblastic leukemia patient with sepsis

概要

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A 69-year-old man with relapsed acute lymphoid leukemia was treated with adriamycin, vincristine, and prednisolone. Duringthis chemotherapy, the patient developed sepsis and meningitis. Although many kinds of antimicrobial drugs, includingimipenem, meropenem, amphotericin-B, and γ-globulin were administered, the patient died of respiratory failure. A positiveresult for Enterococcus faecalis was obtained in both blood and cerebrospinal fluid culture. Autopsy revealed multiple smallerosions in the lower esophagus. Histopathological examination showed multiple nuclear inclusion bodies of herpes simplexvirus in the squamous epithelial cells at the edge of the erosions. Moreover, proliferation of micrococci was observed at thebase of the erosions and in the lumina of the submucosal small vessels. These findings suggested that E faecalis entered theblood circulation from this lesion. In many patients with febrile neutropenia, the pathogenesis of infection remains unclear.Our case seems significant for clarifying the focus and pathogenesis of febrile neutropenia.
日本血液学会の論文
2003-05-01